Imvris v. Michigan Millers Mut. Ins. Co.

• Decision Date: 24 March 1972
• Docket Number: Docket No. 11599,No. 1,1
• Citation: 39 Mich.App. 406,198 N.W.2d 36
• Parties: Peter H. IMVRIS, Plaintiff-Appellee, v. MICHIGAN MILLERS MUTUAL INSURANCE COMPANY, a Michigan insurance company, Defendant-Appellant
• Court: Court of Appeal of Michigan — District of US

Page 36

198 N.W.2d 36

39 Mich.App. 406

Peter H. IMVRIS, Plaintiff-Appellee, v. MICHIGAN MILLERS MUTUAL INSURANCE COMPANY, a Michigan insurance company, Defendant-Appellant.

Docket No. 11599.

Court of Appeals of Michigan, Division No. 1.

March 24, 1972.

Released for Publication June 7, 1972.

Brian D. Einhorn, Plunkett, Cooney, Rutt & Peacock, Detroit, for defendant-appellant.

H. Donald Garfinkle, Lipton, Papista & Garfinkle, Detroit, for plaintiff-appellee.

Before BRONSON, P.J., and V. J. BRENNAN and O'HARA, ^* JJ.

O'HARA, Judge.

This is an appeal taken by leave granted from an order of the circuit court which reversed a holding of the common pleas court. The circuit court's order remanded the matter to the common pleas court with directions to enter a verdict for plaintiff in the amount of $2000.

The trial court furnished us with a carefully considered opinion. We have examined the legal issues involved (and there are only legal issues). We conclude that there is little, if anything, we could add to his opinion. We set it forth In toto.

'This matter is before the Court upon an appeal from the Common Pleas Court. The facts are not in dispute.

'On or about July 10, 1969, the plaintiff was injured when struck by a motor vehicle while a pedestrian. As a proximate result of these injuries, the plaintiff was hospitalized and incurred hospital expenses in excess of two thousand dollars.

'At the time of the plaintiff's injury, there was in existence a policy of insurance issued by defendant to plaintiff which policy contained medical payments provisions as set forth below.

'All of the plaintiff's medical expenses in the accident were paid by the United States Government pursuant to the Medicare provisions of the Social Security Act. It is stipulated by the parties that they were incurred for necessary hospitalization.

'The maximum amount of recovery under the policy is two thousand dollars, and the sole issue for determination by the Court is whether, pursuant to the terms of the policy of insurance, medical expenses paid under the Medicare provisions of the Social Security Act are 'excluded expenses under the policy.'

'The exclusion section of the policy provides as follows:

"This policy does not apply * * *

"Under medical expense coverage to that amount of:

"1. Any medical expense which is paid or payable to or on behalf of the injured person under the provisions of any * * *

"2. individual, blanket or group accident, disability or hospitalization insurance,

"3. medical, surgical, hospital or funeral service benefit or reimbursement plan * * *."

'The trial court held that under the terms of the exclusion, plaintiff was not entitled to recover from the insurance company. The matter is here on appeal.

'The basic issue is whether medical expenses paid by the Social Security Administration under Medicare falls within the medical expenses coverage exclusions contained in the policy, and this, of course, must be determined by whether medical care payments are 'accident, disability or hospitalization insurance' or 'medical, surgical, hospital or funeral service benefits or reimbursement' within the ordinary meaning of these terms as they are contained in the policy in question.

'It is established law that a policy of insurance, written in language chosen by the insurer, must be given a construction most favorable to the insured. An exception arises only when there is no ambiguity in the contract. Defendant contends that there is no ambiguity in this contract, and that the clear meaning of the policy language excludes any payment. It claims that Medicare payments are clearly 'accident, disability or hospitalization insurance' within the ordinary meaning of these terms.

'Defendant cites many authorities and relies upon the general definition of insurance as contained in Webster's International Dictionary, Second Edition, where insurance is defined as:

"An act of insuring against loss or damage by a contingent event; one party undertakes to indemnify or guarantee another against loss by certain specified contingency or peril, called a risk.'

'The basic question is whether social insurance such as Medicare can be accurately described as insurance within the general definition of the term. If there is any ambiguity as to whether it is insurance, then that ambiguity must be resolved against the defendant. If there is no ambiguity, as to whether Medicare payments are insurance, then the defendant must prevail.

'It is true that there are aspects of the Medicare program which are similar to an insurance reimbursement plan. But the basic fact is that Medicare is a social welfare program and not an insurance or reimbursement plan within the everyday and ordinary meaning of these terms. Medicare was added to the existing Social Security laws in 1965 and as yet there have been few, if any, judicial decisions defining its scope. However, in view of the fact that Medicare is part of the more comprehensive Social Security...